探讨经腹腔镜超声引导下微波消融同期治疗结直肠癌肝转移的疗效。

回顾性分析2012年3月至2016年8月广东省中医院收治的66例结直肠癌肝转移患者临床资料。其中男39例，女27例；年龄38～81岁，中位年龄56岁。原发病：直肠癌26例，乙状结肠癌18例，升结肠癌10例，降结肠癌7例，横结肠癌5例。肝转移灶直径≤3 cm，数目≤3，且无其他远处转移。患者均签署知情同意书，符合医学伦理学规定。患者均在腹腔镜下经超声引导微波消融治疗肝转移癌，检查确认无出血及胆漏后转入原发灶的同期腹腔镜手术切除治疗。术后随访观察患者的治疗效果。

单次消融时间5～10 min，单次完全消融率97%（64/66）。微波消融术后发生胸腔积液1例，未发生肝功能不全、穿刺点出血、胆漏、胆管狭窄等消融相关并发症。患者术后肿瘤复发率44%（29/66），其中消融灶局部复发率9%（6/66）。8例患者分别于术后11、14、15、18、22、25、28、33个月死于全身广泛转移，死亡率12%（8/66）。截止至投稿日期58例患者获得生存，其中有37例无瘤生存。

对于直径≤3 cm且数目≤3个的结直肠癌肝转移病灶，腹腔镜超声引导下同期微波消融治疗安全、有效。

To investigate the clinical efficacy of laparoscopic ultrasound-guided microwave ablation for the concurrent treatment of colorectal liver metastasis (CLM).

Clinical data of 66 patients with CLM who were admitted to Guangdong Provincial Hospital of Traditional Chinese Medicine between March 2012 and August 2016 were retrospectively analyzed. Among them, 39 cases were males and 27 were females, aged 38-81 years old with a median age of 56 years old. Primary diseases: 26 cases with rectal cancer, 18 with sigmoid colon cancer, 10 with ascending colon cancer, 7 with descending colon cancer and 5 with transverse colon cancer. The diameter of liver metastatic lesions was ≤3 cm and the quantity was ≤3, and no other distant metastasis was observed. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients underwent laparoscopic ultrasound-guided microwave ablation for the treatment of liver metastases, and were transferred to concurrent laparoscopic resection of the primary lesions after no bleeding or bile leakage was confirmed. The clinical efficacy was observed during the postoperative follow-up.

The single ablation time was 5-10 min. The single complete ablation rate was 97%(64/66). One case of pleural effusion was observed after microwave ablation, and no ablation-related complications such as hepatic insufficiency, puncture point bleeding, bile leakage or bile duct stenosis were observed. The postoperative tumor recurrence rate was 44%(29/66) and the local recurrence rate of the ablation lesions was 9%(6/66). Eight patients respectively died at postoperative 11, 14, 15, 18, 22, 25, 28 and 33 months due to systemic metastasis with the mortality of 12%(8/66). Fifty-eight patients survived including 37 with tumor-free survival until the paper submission date.

Laparoscopic ultrasound-guided concurrent microwave ablation is a safe and efficacious treatment for CLM with the metastatic lesions ≤3 cm in diameter and ≤3 in quantity.